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P APER
A BSTRACTS
creating a barrier to treatment. A simple 3-item measure (the 3IQ)
was developed to facilitate diagnosis, but the efficacy and safety of
using the 3IQ to initiate treatment are unknown.
Methods: In this double-blinded trial, 645 ambulatory women
diagnosed with urgency incontinence using the 3IQ rather than an extended
evaluation were randomized to 12 weeks of pharmacologic
therapy with fesoterodine (4-8 mg daily) (N=322) or placebo
(N=323). Change in urgency incontinence over 12 weeks was assessed
by voiding diaries. Safety was assessed through adverse event monitoring
and measurement of post-treatment postvoid residual volume
(PVR), with specialist referral for PVR ≥ 250 mL or safety concern.
Results: Mean (SD) baseline urgency incontinence frequency
was 3.9(3.0) episodes/day. After 12 weeks, women in the fesoterodine
group reported an average of 0.9 fewer urgency incontinence, 1.0
fewer total incontinence, and 0.9 fewer urgency-associated voids per
day, compared to placebo (P 65 should receive 1-1.5
mg/kg. We determined whether older patients were less likely than
younger patients to be given propofol for induction; whether propofol
dose decreased with increasing age, per published guidelines; and
whether, for patients > 65 years, increasing doses of propofol were associated
with post-induction hypotension.
Methods: We conducted a retrospective multivariate analysis of
data from the Anesthesia Information Management System at Mount
Sinai Hospital with IRB approval. We obtained data for 41,156 cases
age 18-90, undergoing GA between 2006 and 2010, after excluding
cardiac and obstetric cases. Post-induction hypotension was defined
by meeting either of 2 criteria: (1) mean arterial pressure (MAP) decrease
> 40% and MAP < 70 mmHg, or (2) MAP < 60 mmHg.
Results: In the population studied, 31,827 patients (77%) received
propofol. The cohort receiving propofol was younger (53 years
vs. 60 years), non-emergent (88% vs. 75%), and had lower ASA physical
status (51% ASA I-II vs. 23%) (p < 0.001 for each). Propofol dose
decreased with increasing age (Pearson correlation = -0.35). The median
dose for patients 65 population,
47% received > 1.5 mg/kg. A larger dose of propofol was associated
with an increased likelihood of hypotension in the post-induction period,
and this effect was age-dependent. For the same increase in
propofol dose (0.5 mg/kg), a 65 year old was less likely to experience
hypotension than an 80 year old (OR=1.09 vs. 1.15, respectively).
Conclusions: A large cohort of patients > 65 were given higherthan-recommended
doses of propofol for induction of GA. Higher
doses were associated with increased incidence of significant hypotension
in the post-induction period. This is clinically important because
significant post-induction hypotension has been associated
with increased incidence of post-operative adverse events.
Paper Session
Epidemiology
Saturday, May 5
10:45 am – 12:15 pm
P28
Risk Factors for Restricting Back Pain in Community-Living Older
Persons.
U. E. Makris, 1,2 L. Han, 3 L. Leo-Summers, 3 L. Fraenkel, 3,4 T. M. Gill. 3
1. Internal Medicine, UT Southwestern Medical Center, Dallas, TX; 2.
Medicine, Veterans Affairs, Dallas, TX; 3. Internal Medicine, Yale
School of Medicine, New Haven, CT; 4. Medicine, Veterans Affairs,
West Haven, CT.
Supported By: T32 AG019134 Yale Geriatrics Training Program in
Aging Related Research and Clinical Epidemiology; ACR
REF/ASP Junior Career Development Award in Geriatric
Medicine; RO3 AG040653 NIA GEMSSTAR.
Background: Back pain is a common and costly condition
among older persons. Few prospective studies have evaluated the risk
factors for back pain in older persons.
Methods: We evaluated the 731 participants (mean age 78.8
years, 65% women) of the Precipitating Events Project, a prospective
study of community-living persons, aged 70+ years, who completed
monthly interviews of restricting back pain, defined as staying in bed
for at least 1/2 day and/or cutting down on one’s usual activities due
to back pain, for up to 126 months. Candidate risk factors were measured
from five domains (demographic, cognitive-psychosocial, health
related, habitual, physical capacity) during comprehensive homebased
assessments that were completed every 18 months for up to 108
months. Among participants without restricting back pain, two distinct
outcomes were determined during each 18-month interval: (1)
short-term (1 episode lasting 1 month) and (2) persistent (1 episode
lasting >= 2 months) or recurrent (>= 2 episodes of any duration) restricting
back pain. The cumulative incidence of the outcomes were
estimated during the total follow-up period using a GEE binomial
model. A multivariable Cox model was used to evaluate the adjusted
associations between each candidate risk factor and the two outcomes
of interest.
Results: The cumulative incidence was 17.8% (95% CI: 16.5,
19.3) for the short-term outcome and 17.9% (16.1, 19.9) for the persistent/recurrent
outcome. Factors independently associated with a
higher risk of developing short-term restricting back pain included female
sex (HR 1.30, P=0.01), hip weakness (HR 1.19, P=.001) and poor
grip strength (HR 1.24, P=.04); and for the persistent/ recurrent outcome
included female sex (HR 1.48, P=0.01), depressive symptoms
(HR 1.57, P=